接受社區藥局藥師執行整合藥事照護之病人其藥物相關問題的城鄉差異

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題名:	接受社區藥局藥師執行整合藥事照護之病人其藥物相關問題的城鄉差異 Urban-Rural Differences of Drug-related Problems in Patients Receiving Integrated Pharmaceutical Care from Community Pharmacists
作者:	簡君蕙 CHIEN, CHUN-HUI
貢獻者:	藥學系臨床藥學碩士在職專班吳姿樺
關鍵詞:	社區藥局;藥事照護;藥物相關問題;PCNE-DRP V9.0;用藥配合度;藥物治療方案複雜性指數 (MRCI);藥物負擔指數 (DBI);城鄉差異 Community pharmacy;pharmaceutical care;drug-related problems;PCNE-DRP V9.0;medication adherence;medication regimen complexity index (MRCI);drug burden index (DBI);urban-rural differences
日期:	2021-07-15
上傳時間:	2022-04-16 17:27:03 (UTC+8)
摘要:	有效的用藥整合服務及照護模式可以及早察覺病人的藥物相關問題 (DRPs) 並提昇病人用藥安全。本研究目的為瞭解病人藥物相關問題的類型及原因，並比較城鄉之間有藥物相關問題的病人族群特質以及病人對於整合藥事照護的需求差異。研究方法：研究藥師分別在臺北市及宜蘭縣的社區藥局聯繫77位符合收案條件之民眾，分析其用藥整合的成效指標包含多重用藥情形（用藥數≥ 5種）、用藥配合度、藥物治療方案複雜性指數 (MRCI)、抗膽鹼/鎮靜作用藥物之藥物負擔指數 (DBI) 等，並使用PCNE-DRP V9.0記錄病人藥物相關問題。研究結果：共收錄66位個案（66.0± 14.6歲）並分析，每人平均處方藥物總數為6.6± 3.5種，屬於中、低度用藥配合度者分別佔50%、6%。經評估有DRPs佔35%；常見的DRPs為”治療效果不佳”，造成DRPs常見之原因為”患者服藥劑量不夠或根本未服藥”、”患者無法正確理解服藥說明”及”患者服用了不必要的藥物”，常用以解決DRPs的方法為”患者（藥物）諮詢”。依據DRPs、城市/鄉村地區特質分群分析結果如下：有DRPs者比無DRPs者的平均年齡較輕 (p<.05)、用藥配合度較低 (p<.01)。城市地區病人較鄉村地區有較多之多重用藥人數（28人vs. 17人）及MRCI (19.9 10.2 vs. 11.9 3.6) (p<.01)；然而城市地區病人中，用藥數少於五種的族群有較高的單一藥品MRCI (p<.01)，且因不當的生活飲食習慣導致疾病控制不佳的情況較鄉村地區多。鄉村地區病人zolpidem使用率較城市地區高，但其藥物使用者經評估未發現有藥物相關問題；而多重用藥者（鄉村地區佔52%），其年齡及就診科別總數較無多重用藥者高 (p<.05)，且常因無法理解正確的服藥說明，導致服藥劑量不夠或根本未服藥。結論：本研究結果顯示所收錄之城市和鄉村病人對於藥師提供之整合藥事照護的諮詢服務需求性不同：城市執業藥師可著重在處方複雜度及改善生活飲食型態之衛教；鄉村執業藥師可著重在疾病知識及用藥指導。整體來說，藥師於病人每月來藥局領藥時，可藉由病人用藥配合度察覺病人潛在DRPs。 Pharmacists can aware drug-related problems (DRPs) and improve patients’ safety by conducting effective integrated pharmaceutical care. This study aims to clarify types and causes of DRPs, and compare the characteristics of the patients. The study also compared the differences between patients living in urban and rural areas from those who were in the need of integrated pharmaceutical care. Method: The pharmacist contacted 77 patients who were conformed to the inclusion criteria at the community pharmacies in Taipei City and Yilan County. The evaluation indicators include polypharmacy, medication adherence, medication regimen complexity index (MRCI), drug burden index (DBI) of anticholinergic/sedative drugs, etc. Use PCNE-DRP V9.0 to record patient’s DRPs. Results: 66 cases (66.0± 14.6 years old) were enrolled and analyzed the data in the study. Among the participants, the average number of prescription drugs was 6.6± 3.5. Moderate and low medication adherence accounted for 50% and 6%. A total of 35% of the participants had DRPs. DRPs were "effect of drug treatment is not optimal". Causes of DRPs were "patient uses/takes less drug than prescribed or does not take the drug at all", "patient is unable to understand instructions properly" and "patient uses unnecessary drug". The method to solve DRPs is "Patient (drug) counselling". The results of the subgroup analysis were as follows: Patients with DRPs had younger average age (p<.05) and lower medication adherence (p<.01) than those without DRPs. The results showed that urban areas had higher polypharmacy (28 people vs. 17 people) and MRCI (19.9 10.2 vs. 11.9 3.6) (p<.01). However, patients who take less than five prescription drugs had a higher mean MRCI (p<.01) in urban areas. Besides, poor disease control because of poor lifestyle and diet patterns were more severe in urban areas. The prescription rate of zolpidem in rural areas was higher, but the pharmacist did not aware any DRPs among those patients. Furthermore, patients had polypharmacy in rural areas were older and visit different medical departments frequently (p<.05). Besides, patients often fail to understand the correct medication instructions, resulting in insufficient medication doses or not taking medication at all. Conclusion: The results showed that patients included in this study have urban-rural differences in the needs of pharmacists’ integrated pharmaceutical care: Pharmacists in urban areas can focus on medication complexity and health education for improving lifestyle and diet patterns. While in rural areas, pharmacists can focus on the knowledge of diseases and medication guidance. Overall, pharmacists can aware potential DRPs of patients by evaluating medication adherence when the patient comes to the pharmacy to refill the medicine every month.
描述:	碩士指導教授：吳姿樺委員：盧孟良委員：黃安正
資料類型:	thesis
顯示於類別:	[藥學系] 博碩士論文

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